Provider Demographics
NPI:1134514813
Name:REDDY, NISHIKA MUDDASANI (MD)
Entity Type:Individual
Prefix:
First Name:NISHIKA
Middle Name:MUDDASANI
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NISHIKA
Other - Middle Name:REDDY
Other - Last Name:MUDDASANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4445 LAKE FOREST DR
Mailing Address - Street 2:STE 600
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3744
Mailing Address - Country:US
Mailing Address - Phone:513-569-3741
Mailing Address - Fax:
Practice Address - Street 1:915 OLENTANGY RIVER RD FL 5
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3153
Practice Address - Country:US
Practice Address - Phone:614-293-8116
Practice Address - Fax:614-293-4719
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35136562207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0358195Medicaid